Gracie's Story: Her Dental Day at Lombard Animal Hospital

The following is a photo-documented summary of 

Gracie’s Story: Her Dental Day at Lombard Animal Hospital 

located in Portland, Oregon

Gracie’s teeth were assessed during her annual exam.  At that time, Dr. Preston noted moderate tartar and plaque on most teeth, with some teeth more heavily affected than others.  Plaque was pushing up against the gum line causing some gingivitis. Dr. Preston recommended an anesthetic dental procedure to assess the teeth thoroughly for periodontal disease beneath the gum line and to remove the plaque, preventing further damage to the teeth.

Gracie checks in early this morning (7:30 am) with Alese and Lauren, Lombard Animal Hospital Veterinary Assistants, for pre-operative preparations. :

•  Blood draw and analysis – helps determine the patient’s health status and ability to process anesthetic drugs and medications.
• Pre-medication: pain medication and a mild sedative given before placing an IV Catheter.  Provides relaxation and pain relief for the patient. An antibiotic and anti-inflammatory injection are also given in most cases. 
•  IV catheter placement – provides a port for anesthetic drug administration, supportive IV fluids, and emergency medications if necessary.

Once the IV catheter is in place and all of the equipment is ready to go, Dr. Preston administers the IV medication necessary to put Gracie under anesthesia (pictured below).

 Dr. Preston intubates Gracie with an endotracheal tube (pictured below) in order to:

•   Maintain consistent anesthesia with gas and oxygen
•   Provide an open airway at all times
•   Prevent backflow of saliva and fluids into the trachea and lungs

During the entire dental procedure, an Assistant or the Doctor measures and records Gracie's vital signs: Heart Rate, Respiratory Rate, Capillary Refill time, Temperature.  A heated water blanket is used to keep the patient's temperature as close to normal as possible.  Blood pressure is monitored using a Doppler machine.  IV fluid therapy helps to keep blood pressure normal, hydrates the patient and flushes anesthetic byproducts from the system.  

The only way to truly assess your pet’s mouth is to perform an examination while your pet is under anesthesia.  The veterinarians at Lombard Animal Hospital in Portland, Oregon use a dental probe (pictured above) to measure any loss of attachment around each tooth. In Gracie’s case, a slab fracture was discovered in one of her right upper premolars.  It was also noted after scaling the plaque away from the teeth that her gingivitis was more severe than noted during her annual exam 5 months ago.  Her gums bled very easily due to the inflammation.

 If there is loss of attachment, a pocket of infection, a fracture, or other dental lesion, we take

  digital dental radiographs (X-rays, pictured below) to assess for bone loss, abscesses, unhealthy roots and other problems. The radiograph determines whether or not extraction of the tooth is the best choice for your pet.  In Gracie’s case, the the radiograph revealed an enlarged pulp chamber (pulp/root infection). Due to infection and the likelihood of pain, Gracie will benefit from extraction of this tooth.  

Extractions are performed using sterile dental tools and/or a high speed dental drill (drill pictured below). Drills are not as scary as they sound. In fact, they allow the veterinarian to extract the tooth more quickly, with less damage to surrounding tissue. In teeth with multiple roots, like Gracie’s premolar, the tooth must be divided by the drill (below, right)  so that it can be extracted with the least amount of damage to the pet’s gum. Many times the extraction sites will heal on their own. In some cases, sutures (stitches) may be required. 

Extraction Site Pictured Below 

Once all teeth have been evaluated by the Doctor and the necessary radiographs and extractions performed, a veterinary assistant finishes scaling and polishing the teeth.  The mouth is thoroughly rinsed and inspected one more time by the veterinarian.

BEFORE AND DURING SCALE AND POLISH (ABOVE AND BELOW)

AFTER SCALE AND POLISH (BELOW)

Now that Gracie’s dental procedure is finished, anesthesia is turned of and she enters the  Post-Operative or Recovery Period.  During this time, her vital signs (heart rate, respiratory rate, temperature) are closed monitored by the Doctor and Assistant.  Once she is alert and able to swallow, the endotracheal tube is pulled out and monitoring continues until she is fully awake.  Most pets stay with us at Lombard Animal Hospital until between 3:30 and 5 pm.  This way we can ensure that they are fully functional before heading home to spend the evening with their people. 

Gracie is bright-eyed and ready to go home!  She will feel much better without that infected tooth and her breath will be fresh too!

During Gracie's discharge appointment, the Doctor goes over the procedure with her owner.  

They discuss lesions, X-rays and extractions.  

The Assistant goes over post-operative pain medications and antibiotics that will be administered at home.  Preventative dental health measures, such as tooth brushing and supplements, are recommended. 

We also prepare the owner on monitoring for abnormal swelling, discharge or other symptoms that may indicate a complication.  Most pets are groggy for the first 24 hours after an anesthetic procedure, but should perk up and eat normally within 36 - 48 hours.  Most patients are able to eat their usual food, but if not, diet recommendations will be made.  

An assistant will call in the morning to check on Gracie. At Lombard Animal Hospital in Portland, Oregon, we always offer one complimentary post operative exam to ensure that the gums and extraction sites are healing appropriately.  

We'll be happy to see Gracie again in 5-7 days. She is a wonderful patient!

February is National Pet Dental Month.  At Lombard Animal Hospital in Portland, Oregon we offer 10% off the entire procedure for each pet, whether they require only a prophylactic cleaning or major extractions. 

 Please call us at  503.285.2337 to schedule your pet's exam or dental procedure. 

 We would love the opportunity to provide a "pawsitive" experience for you and your pet!

Lombard Animal Hospital

607 NE Lombard Street

Portland, Oregon 97211

www.lombardanimalhospital.com

**The contents of this article are not intended to replace professional medical advice.

Case Study: The value of one feline's annual wellness exam

 “Princess”  Presented for an annual wellness exam.

13 Year-Old, female, Domestic Long Haired Cat. Stays indoor except for short excursions into the backyard on sunny days. 100% dry, grocery brand diet.

On paperwork, Owner responded that the pet had been drinking “a little more water” than usual.

The owner has no concerns and reports that the patient is “slowing down a bit” but is otherwise happy at home.

Physical exam: Mild weight loss noted with slight muscle atrophy of the hind limb muscles.

Eyes, Ears, Nose and throat:  normal.  Gums a little dry, but nothing remarkable.

Abdominal palpation:  normal, abdominal organs are normal size and shape.   Lymph nodes: normal size.

Heart: normal rate and rhythm.  Lungs: normal sounds.

Musculoskeletal system: normal other than low back and hind limbs.  The low back is sensitive to pressure and the hips have decreased range of motion.

Clinical impression based on physical exam and history:

The patient has a mild increase in water intake which could indicate abnormalities of the renal (kidney) system, liver, thyroid, or adrenal glands. Diabetes is unlikely based on symptoms, but can not be ruled out without lab testing.  Increased water intake can also occur with discomfort or pain.  Muscle wasting, sensitivity and decreased range of motion in the hind end can indicate arthritis.  The slightly dry gums, despite increased water intake, indicate mild dehydration.   This increases suspicion of early renal disease.

Plan presented to owner:

Health Screening Profile to the Lab – Complete Blood Count (CBC), Serum Chemistry Panel, Urinalysis.

Fecal Float to the Lab – screens for intestinal parasites (part of LAH Healthy Pet Plan)

Subcutaneous fluid treatment – to boost hydration, regardless of reason for mild dehydration – it helps and it makes the pet feel better!

No additional recommendations until the lab results are in.

Wait on vaccines that are due until lab results are in. 

Total Cost of Appointment - approximately $240.00

Results:

CBC: Red blood cell (RBC) count - normal, White blood cell (WBC) count - normal.

Chemistry panel: Mild elevation in BUN/Creatinine (45/2.0) the 2 main values use do evaluate the kidneys. These values increase when the kidneys are not performing at least 2/3 normal function.  Blood Glucose - normal (makes diabetes unlikely). Liver values - normal. Thyroid value - normal.

Urinalysis:

Lower than normal urine concentration (Specific gravity 1.020): dilute urine, combined with elevations in BUN/Creatinine supports the diagnosis of early to middle stage renal insufficiency.

Fecal Float: No parasites or pathogenic bacteria seen.

Diagnosis: Early to middle stage renal insufficiency. (The kidneys are not performing at a high enough level to keep the patient well hydrated through adequate urine concentration. They are insufficiently clearing BUN/CRET, the end products of protein digestions, from the bloodstream.)

Treatment Options/Plan:  Discussed results with owner over the phone.  Advised owner that since the patient’s vital signs and quality of life are stable, there are some good conservative options for slowing down the progression of renal insufficiency.  These include:

·       A 100% canned, moderate protein level, but high quality food

o   The canned option provides the increased moisture to aid with mild dehydration.

o   The moderate protein level prevents muscle wasting while not making the workload on the kidneys too intense.

o   The high quality protein results in less end-byproducts of digestion, which helps to keep BUN/Creatinine at a reasonable level.

·       Feline Renal Support Supplement ($17.00 for 60 Tablets = 1-2 months of treatment depending on dose)

o   Nutritional support specifically targeting the kidneys.

·       Subcutaneous fluid therapy at home: 1 treatment per week. ($23.30 for 1 Kit = 6-10 treatments)

o   We can teach the owner how to administer fluids under the skin. This results in increased hydration and perfusion (circulation) of the kidneys. This is not required at this stage of renal disease, but could definitely slow down progression into the later stage in which they will be necessary for quality of life. 

·       Recheck a smaller lab screening panel in 1 month to see if the patient’s health status is improved, or at least maintained, by our treatment protocol.  This panel will be recommended every 3-6 months depending on patient’s health status and how they respond to treatment ($58.62).  The full panel presented earlier in this plan will be recommended at each Annual Exam, as it is for all senior patients.

·       Alternative medicine consult or Acupuncture: Discussed in more detail if owner interested. ($74.00 initial consult/treatment, $55.00 each follow up. Most renal insufficiency patients receive a treatment every 3-4 weeks.)

Prognosis: Each pet is unique, but many cats diagnosed in early renal insufficiency can live several years without progressing into the next phase if treated with a protocol as described above.  Appropriate nutrition is paramount to increasing their quality and length of life. 

(More time with your healthier, happier pet … Priceless!)

We present the best available options, the owner makes the decisions!  You decide which options fit with your beliefs, your lifestyle and your budget. As doctors and advocates for the patient, we’d like to do it all. However, we realize that is not always possible. At LAH we strive to enhance the quality of life for pets and their people. If we can move toward this goal, we consider it a success.

*This content in this article is not intended to substitute for veterinary medical advice.  

**The patient's name has been changed for the purpose of anonymity. 

Holiday Pet Stories from the Staff!

Please remember to be cautious when decorating this Holiday Season! Our pets are curious...and sometime too curious and playful for their own good!

Here are some of our personal accounts...

"When one of my cats was about 6 months old it climbed up into the Christmas Tree to play with dangling ornaments.  It made its way about 2/3 up the tree then out to the end of a branch and tipped the tree completely over!  Needless to say, the kitten had a field day with all the ornaments lying on the floor!"  -- Janeen "Coors (the cat featured above) may look innocent in this picture, but one year he ate multiple pine needles that bunched up in his stomach causing vomiting, pancreatitis, and secondary liver disease.  It took Dr. Preston and I  8 weeks to get make our own cat well again...now we have a fake tree!"   -- Dr. Nell "I'll never forget the year Pimpy, our Jardines Parrot, was accidentally left unattended.  He took the liberty of opening (shredding) all of the wrapped gifts under the tree"  -- Dr. Preston Remember to visit Lombard Animal Hospital for safe and nutritious stocking stuffers this year! We will be featuring our favorites all month long on Facebook! Facebook Page

Belle's Story: A Big Loser

Belle is now a healthy 11.2 pound, 11 year old Female Domestic Cat.  However, she wasn't always this svelte.  Her story at Lombard Animal Hospital begins in May 2008 when she was seen for her annual exam and weighed in at a whopping 21.3 pounds and a body condition score of 8/9.
 (Body Condition Score is a measurement veterinarians use in addition to body weight, in order to assess whether a pet is too heavy, too thin or just right for their frame. See links at the bottom of the page.)

Before - A bit Round, 21.3#!

After - Thinned Down, 11.7#!

Weight loss was discussed during the exam and she had no other health concerns at that time.  Then in June, Belle began to have issues with constipation and gastritis.  Like many overweight cats, Belle stopped eating which actually made her sicker.  Xrays and an ultrasound revealed that Belle had hepatic lipidosis, or "fatty liver."  

Hepatic lipidosis is a disease that occurs when overweight or obese cats stop eating due to an underlying cause.  This cause can be as innocent as a stressful situation to as devastating as cancer.  In Belle's case, we suspected stress related gastritis (stomach upset) leading to a loss of appetite.
"The modern house cat has every opportunity to become overweight and while this may not be of disastrous consequence on a day to day basis, should the cat get sick or lost and stop eating, a very big problem erupts. The fat stores mobilize. Normally, in starvation fat is moved from the body's storage depots to the liver for processing into lipoproteins but the feline liver was never intended to handle huge amounts of mobilized fat. The liver becomes infiltrated with fat and fails" (Wendy C. Brooks, DVM, DipABVP , VIN Pet Health Library).

Hepatic Lipidosis is only one of many health issues that can occur in overweight pets. Luckily for Belle, her owners took her nutrition plan very seriously and she was able to safely lose 10 pounds over 2 years.  Belle's weight goal and a body condition score of 5/9 was mainly achieved by implementing a twice daily feeding schedule and measuring her caloric intake.  Calories in must be less than calories out! It sounds easy, but can be overwhelming for many pet owners.  When beginning a weight loss plan for your pet, it is best to seek the advice of your veterinarian. They can help you set realistic, healthy targets and ensure that your pet is eating a diet that is appropriate to their individual health needs. 

Below is a guideline for calculating caloric intake for gradual, healthy wt. loss:

{(Your Pet's Body Weight in Pounds X 15) + 70 } x 0.80 = _____ kcal daily for wt. loss

Below is a guideline for calculating caloric intake for maintenance once target is reached:
(Your Pet's Body Weight in Pounds X 15) + 70 = ______ kcal daily for maintenance

Charts to evaluate your pet's Body Condition Score (click on links below):

Cats

Dogs

*If you would like more information or to schedule a nutrition evaluation and consult for your pet, please give us a call: 503.285.2337

Pally's Story: Preventing Chocolate Toxicity

Pally, a super-sweet spayed female boxer mix, was about 7 months old and 40 lb. when she was able to sneak away approximately 2 oz of dark chocolate.  Luckily, being a young and inexperienced pup, she was brazen enough to do it right in front of her owner! (I know what you're thinking... hard to believe this little gal would cause any trouble, right?)

Her person quickly called Lombard Animal Hospital and, within 25 minutes of ingesting the chocolate, Pally was admitted by Dr. Preston.  Because her owner acted fast, Pally simply needed an injection of apomorphine to induce vomiting* and prevent the toxic effects of theobromine (the compound in chocolate that is toxic to pets).  Pally threw up 5 piles of chocolatey liquid from ingesting just 2 oz!
When Dr. Preston checked in on his patient the next day, she was acting normally and had already eaten her breakfast with no symptoms of gastritis (stomach upset).  Thus, no further treatment was necessary...good for Pally, and great for her person too!

*Note: Do not try to induce vomiting at home. There can be dangerous secondary effects, such as esophageal ulceration and aspiration pneumonia, when not performed appropriately.

Not all pets who ingest chocolate are as lucky as Pally! Some of them are not treated as quickly and can experience serious health effects from ingesting theobromine such as:

• Vomiting and/or Diarrhea
• Tremors, Shaking, Agitation or Hyperactivity
• Dehydration
• Seizures

Theobromine can stay in the system for up to 4 days.  When pets are not treated promptly, they may need to spend 1-4 days in the hospital on Intravenous fluids and supportive care.  Treatment is based on when the chocolate was ingested and the clinical symptoms of the pet during physical exam. 

In addition to theobromine, chocolate also contains fat and sugar.  These components can easily cause gastritis and pancreatitis (inflamed pancreas) in our 4-legged friends.  Milk chocolate contains less theobromine, but more fat and sugar.

Take Home Points:

• Contact your Veterinarian as soon as you suspect chocolate ingestion...no matter how much or how long ago it may have occurred!
• Usually, if your vet is able to see the patient within an hour of ingestion, vomiting will be induced and further treatments may not be necessary as long as your pet is not symptomatic. 
• *Do NOT attempt to induce vomiting at home.
• If greater than an hour is passed, your vet will determine the best way to treat your pet. Some type of fluid therapy and supportive care will most likely be necessary.
• As a general rule, it only takes 0.25 - 0.5 oz of dark chocolate per 10 lb. body weight to cause theobromine toxicity.  The darker the chocolate, the higher the concentration of theobromine. 
• Gastritis and Pancreatitis can occur from any amount or type of chocolate ingestion.

All's well that ends well! -- Pally

Acupuncture Success Story - Corkie!

"Corkie and Alese"

An LAH Super Senior and an LAH Super Assistant

This is Corkie, a 9 year-old spayed female Chihuahua who came to see Dr. Preston for pain and difficulty walking.  During her exam, it was noted that Corkie had decreased neurologic function in her left front and both rear legs.  She was lacking conscious proprioception in these three limbs, the awareness of position and ability to move body segments correctly.  Corkie was diagnosed with Intervertebral Disc Disease.  In short, one or more of the discs that are found in between the vertebra were inflamed, causing pressure on the spinal cord and associated nerves.

Corkie did respond to anti-inflammatories.  She felt better and her conscious proprioception improved in the rear limbs, but she was not back to normal. Her left front limb was still markedly affected and she could not and would not go up and down stairs. Dr. Preston discussed acupuncture with Corkie's owners and she was referred to Dr. Nell for treatment.  Dr. Nell evaluated Corkie using both Western and Eastern exam techniques.  Specific acupuncture points were chosen to decrease inflammation, treat pain and restore appropriate circulation (Western). From a Traditional Chinese Medical (TCM) standpoint, points were chosen to treat pain, resolve Phlegm, and restore the appropriate flow of Qi and Blood.

During the first treatment, conscious proprioception was restored to Corkie's left front limb.
After Corkie's second treatment, she went up and down the stairs of her own accord.
By the third treatment, Corkie's owner felt that she was 100% better.

Corkie will continue to be seen for acupuncture every 4 weeks or as needed for Intervertebral Disc Disease (IVDD).  It is important to have realistic goals when using acupuncture as treatment for disease, especially structural disease such as IVDD and arthritis.  Acupuncture can not alter structure, and therefore will not cure these medical issues. However, it can reduce inflammation, decrease pain and restore function.  In Corkie's case, it helped her to regain a normal quality of life!

"Corkie responded very well to acupuncture. It was really helpful and we will recommend it to others!"

-- Corkie's Family

If you would like to explore acupuncture as a treatment option for your pet, please call and schedule a consult with Dr. Nell.  We are here to help - 503.285.2337

Don’t let the heat drain you or your pets!

Getting outdoors with your pet is great, but....

We all know it is easy for us and our pets to get dehydrated during the hot, sunny days of Summer.  In Chinese medicine, this would be explained as Yin deficiency.  In short, excess heat dries up the Yin portions of the body.  Yin is the cooling, hydrating quality of our health.  Thus, it is just as important to boost Yin as it is to avoid heat!

• ·      Provide plenty of cool, fresh water for pets all day long!
•  
• ·      Ensure that your pet can get away into the air conditioning or shade!
•  
• ·      As a treat, offer 2 tablespoons (dogs) or 1 tablespoon (cats) of Greek, nonfat yogurt!

To learn more about Yin, Yang and the Energetics of Food as they relate to your pet’s diet, schedule a Nutrition Consult with Dr. Nell or consider attending her free Nutrition Class at Healthy Pets Northwest (Alberta St. Location) in September!